{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHEYENNE SHINHOLSER","gend":1,"add":"1820 RAMBLEWOOD RD","city":"PETERSBURG  ","state":"VA","zip":"23805-9998","dob":"1997-02-12","age":"","mstatus":"","insh":11004548,"cliId":"8FJ6EN0XP47","pno":8048544072,"cno":7576030686,"email":"","ename":"","eno":"","pphy":"LONG, JAMES ","ppno":8046938800,"pcpadd":"7519 Hospital Dr","pcpcity":"Gloucester  ","pcpstate":"VA","pcpzip":230614178,"pcpcounty":"","pcpid":"P0126750","pcpname":"INTERNAL MEDICINE ASSOCIATES OF GLOUCESTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"3348 WILLOW LANE  ","madd2":"","madd3":"","mcity":"HAYES ","mstate":"VA","mzip":"23072-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["R21","L01.00","F71","R09.81","J02.9","R05","G40.89","J98.8","R80.9","N91.0","R30.0","Z79.899","Z00.00","R07.9","F43.12","J30.89","C50.119","R56.9","Z51.81","F79","G40.309","N30.90","Z00.01","F33.0","F41.1","F42.4","F98.4","G31.84","G40.B09","G47.00","K08.9","M54.5","R47.89","Z68.25","Z79.1","F39","Z00.8","M79.662","R60.0","M54.42","R20.0","G89.29","Q68.4","R62.50","L71.0","H02.409","E55.9","L50.9","F43.9","Z23","L98.1","Z13.6","F31.81","N64.4","N63.20","N63.22","F43.10","L98.499","L08.9","J30.9","N39.44","Z11.1","N77.1","Z12.4","Z30.09","Z30.9","Z11.3","Z30.013","K59.00","J06.9","E88.81","D69.6","R11.11","R39.81","K04.7","K08.89","K02.9","E66.9","F31.9"],"date":["2020-01-07","2020-01-07","2020-01-23","2019-02-06","2019-02-06","2019-02-06","2020-12-09","2019-02-26","2019-04-10","2019-04-10","2021-03-18","2021-10-08","2019-03-06","2020-12-08","2021-09-23","2019-05-01","2020-10-01","2021-10-26","2018-08-13","2021-10-26","2018-09-07","2020-12-09","2020-12-09","2018-09-12","2020-12-08","2018-09-12","2018-09-12","2018-09-12","2018-09-12","2018-09-12","2018-09-12","2018-09-12","2018-09-12","2018-09-12","2018-09-12","2021-10-26","2019-09-25","2019-09-25","2019-09-25","2021-10-26","2019-09-25","2021-10-26","2019-09-25","2019-09-25","2019-09-25","2019-09-25","2021-08-23","2020-10-08","2018-10-18","2021-04-30","2021-10-26","2018-10-19","2018-10-23","2019-11-13","2019-11-13","2019-11-13","2018-11-27","2019-12-15","2019-12-15","2021-04-02","2021-03-10","2021-03-18","2021-05-06","2021-03-16","2021-03-16","2021-03-18","2021-04-20","2021-03-18","2021-05-06","2021-06-01","2021-08-23","2021-08-23","2021-09-17","2021-10-09","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-10-08"],"priorHcc":["","","","","","","","","","","","","","","","","",null,"",null,"","","","","","","","","","","","","","","",null,"","","",null,"",null,"","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","16729006416","LEVETIRACETA","TAB 250MG","","Select","Select",""],["","59148003613","REXULTI","TAB 0.5MG","","Select","Select",""],["","378623305","CITALOPRAM","TAB 40MG","","Select","Select",""],["","185067405","HYDROXYZ PAM","CAP 25MG","","Select","Select",""],["","62756079813","DIVALPROEX","TAB 500MG DR","","Select","Select",""],["","68001027900","DICLOFENAC","TAB 25MG DR","","Select","Select",""],["","62332009830","ARIPIPRAZOLE","TAB 5MG","","Select","Select",""],["","68382080510","TRAZODONE","TAB 50MG","","Select","Select",""],["","93314705","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","","Select","Select",""],["","93742656","MONTELUKAST","TAB 10MG","","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","59746017710","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","60505083001","MOMETASONE","SPR 50MCG","","Select","Select",""],["","172541211","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","69238110305","IBUPROFEN","TAB 800MG","","Select","Select",""],["","59310057922","PROAIR HFA","AER ","","Select","Select",""],["","47781030801","NITROFUR MAC","CAP 100MG","","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","","Select","Select",""],["","548570100","MEDROXYPR AC","INJ 150MG\/ML","","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","406037605","HYDROCO\/APAP","TAB 5-300MG","","Select","Select",""],["","45802011222","MUPIROCIN","OIN 0.02","","Select","Select",""],["","54327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","93742656","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","185067405","HYDROXYZ ","CAP 25MG","45","Select","Select",""],["","93314705","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","62332009830","ARIPIPRAZOLE ","TAB 5MG","31","Select","Select",""],["","378623305","CITALOPRAM ","TAB 40MG","31","Select","Select",""],["","68382080510","TRAZODONE ","TAB 50MG","31","Select","Select",""],["","16729006416","LEVETIRACETA ","TAB 250MG","93","Select","Select",""],["","59148003613","REXULTI ","TAB 0.5MG","31","Select","Select",""],["","62756079813","DIVALPROEX ","TAB 500MG DR","62","Select","Select",""],["","68001027900","DICLOFENAC ","TAB 25MG DR","62","Select","Select",""],["","60505083001","MOMETASONE ","SPR 50MCG","17","Select","Select",""],["","59746017710","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","172541211","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","47781030801","NITROFUR ","CAP 100MG","14","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","20","Select","Select",""],["","65862001705","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","49502010202","EPINEPHRINE ","INJ 0.3MG","1","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","548570100","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","45802011222","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","16714049401","AMOX\/K ","500-125","20","Select","Select",""],["","406037605","HYDROCO\/APAP ","5-300MG","9","Select","Select",""],["","00185067405","HYDROXYZ","25MG","45","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","16714049401","AMOX\/K","500-125","20","Select","Select",""],["","47781030801","NITROFUR","100MG","14","Select","Select",""],["","16714099901","MEDROXYPR","150MG\/ML","1","Select","Select",""],["","59310057922","PROAIR","","8.5","Select","Select",""],["","65862018601","CLINDAMYCIN","300MG","30","Select","Select",""],["","57237004105","PENICILLN","500MG","40","Select","Select",""],["","65862018601","CLINDAMYCIN ","CAP 300MG","30","Select","Select",""],["","57237004105","PENICILLN ","TAB 500MG","40","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}